New advances in the management of juvenile idiopathic arthritis—1: Non-biological therapy

Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease with significant long-term morbidity and mortality. Major advances have taken place in recent years in our understanding and the evidence base of JIA.Key to this has been the serious collaborative efforts of clinicians, academics, scientists and the whole of the multidisciplinary team. This has led to the important recognition and development of specialised expertise for the management of patients, improvement in global outcome measures and aggressive treatment of the significant complications of JIA.Important steps have taken place in optimising treatment of JIA. Clinical trials demonstrate that early use of intra-articular corticosteroid injections alone or in addition to other systemic treatments can have a long-lasting effect. Robust evidence has defined the importance of methotrexate as the first-line disease modifying anti-rheumatic drug in JIA. Newer treatment options in severe refractory disease are now available including stem cell transplantation.This review focuses on the recent advances in non-biological therapies for treating JIA.